Review of Cardiac Rehabilitation Services at Spencer Municipal Hospital, Spencer, Iowa

EXECUTIVE SUMMARY:

The objectives of this review were to determine whether:  (1) Spencer Municipal Hospital's (Spencer) policies and procedures reflected Medicare cardiac rehabilitation coverage requirements for direct physician supervision, 'incident to' services, and Medicare covered diagnoses; and (2) payments to Spencer for outpatient cardiac rehabilitation services provided to Medicare beneficiaries during Calendar Year 2001 were for Medicare covered diagnoses, were supported by adequate documentation, and were otherwise allowable for reimbursement.  Physician involvement in the outpatient cardiac rehabilitation program at Spencer needs to be better identified.  Spencer did not designate a physician to directly supervise the services provided by its cardiac rehabilitation staff.  Also, contrary to current Medicare requirements, we could not identify the physician professional services to which the cardiac rehabilitation services were provided 'incident to.'  In addition, our review showed physicians signing referrals after the patient started rehabilitation and not signing off on approvals for the discharge of their patients from the cardiac rehabilitation program.  Concerning the reported diagnoses and documentation, we determined that Medicare paid $4,026 for services for 16 beneficiaries with a diagnosis of stable angina pectoris.  The diagnosis may not have been supported in the medical records.